Surgical removal of a benign pelvic mass usually improves women’s pre-existing lower urinary tract symptoms (LUTS), study findings suggest.
Kristina Cvach (Mercy Hospital for Women, Melbourne, Australia) and colleagues prospectively studied 29 women due to undergo surgery for a large pelvic mass – either a uterine fibroid or ovarian cyst measuring 7 cm or greater.
All women also reported bothersome LUTS; 31.0% had urinary frequency, 20.7% had stress urinary incontinence, 13.8% had urgency incontinence, 13.7% had mixed urinary incontinence and 36.0% had voiding dysfunction.
The majority of masses were fibroids; 76% of women had a fibroid only, 14% had an ovarian cyst only and 10% of women had both a cyst and a fibroid. The most common surgical approach was an open hysterectomy, performed in 20 of 29 women; other procedures included laparoscopic or vaginal hysterectomy (n=3), myomectomy (n=5) and open ovarian cystectomy (n=1).
Mean total scores on the Urogenital Distress Inventory-6 (UDI-6) fell from 32.9 before surgery to 11.0 after surgery; this was a statistically significant 66% relative decline.
Scores on each domain of the UDI-6 also fell after surgery, indicating significant improvements in frequency, urgency incontinence, stress incontinence, voiding dysfunction and pain.
Mean total scores on the short-form of the Incontinence Impact Questionnaire (IIQ-7) decreased significantly after surgery, from 25.44 to 8.70, as did scores on the physical, entertainment, travel, emotional and frustration domains.
Fibroid volume was weakly positively correlated with the change in IIQ-7 and UDI-6 scores. Postoperative urodynamic studies conducted in a subset of women revealed an increase in the volume at which urgency was experienced, as well as resolution of urinary retention in two women with this symptom preoperatively.
Writing in the International Urogynecology Journal, Cvach et al state that this is the first prospective study using validated condition-specific questionnaires to assess the impact of surgical removal of a pelvic mass on pre-existing LUTS.
They conclude: “We were able to demonstrate that women undergoing removal of a pelvic mass greater than or equal to 7 cm had significant improvement in overall urinary symptom bother and quality of life.”
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